糖尿病病程联合24 h-UPr和β-CTX对2型糖尿病视网膜病变的诊断价值  

Diabetes course, 24 h-UPr and β-CTX for predicting diabetic retinopathy in patients with type 2 diabetes mellitus

作　　者：叶立芳 祝聪 杨训俊 李姗姗[1] YE Lifang;ZHU Cong;YANG Xunjun;LI Shanshan(Department of Clinical Laboratory,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,China;不详)

机构地区：[1]温州医科大学附属第二医院临床检验中心,325027 [2]温州医科大学附属第二医院内分泌科,325027

出　　处：《浙江医学》2024年第11期1130-1134,1141,共6页Zhejiang Medical Journal

摘　　要：目的通过研究2型糖尿病(T2DM)患者合并糖尿病视网膜病变(DR)的相关因素,探寻可能有价值的预测指标。方法回顾性分析2020年1月至2021年12月温州医科大学附属第二医院内分泌科收治的356例T2DM患者临床资料,根据眼底彩照和(或)眼底造影结果,分为DR组和非DR组(NDR组),采用两独立样本t检验、Mann-Whitney U检验和χ^(2)检验分析两组患者基线资料、生化相关指标、骨转换标志物和细胞因子表达水平,多因素logistic回归分析T2DM合并DR的相关因素,ROC曲线评估糖尿病病程、24 h尿蛋白定量(24 h-UPr)和Ⅰ型胶原交联C-末端Beta特殊序列(β-CTX)对T2DM合并DR的诊断效能。结果DR组与NDR组糖尿病病程、收缩压、24 h-UPr、血肌酐、血尿素氮、内生肌酐清除率、胱抑素C、尿β2微球蛋白、β-CTX、骨钙素N端中分子片段和25-羟基维生素D比较,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示β-CTX(OR=0.997,P<0.01)是DR的保护因素,糖尿病病程(OR=1.118,P<0.01)、24 h-UPr(OR=3.431,P<0.05)是T2DM合并DR的危险因素。糖尿病病程、24 h-UPr和β-CTX联合检测预测DR的ROC AUC为0.769,灵敏度为0.701,特异度为0.696;ROC曲线最佳截断值分别是8.5年、0.135 g/24 h和500 pg/mL。结论较低的β-CTX水平,较长的糖尿病病程和较高的24 h-UPr水平是T2DM合并DR的独立危险因素,3项指标联合检测对T2DM合并DR具有较好的预测价值。Objective To investigate risk factors of diabetic retinopathy(DR)in patients with type 2 diabetes mellitus(T2DM),and their predictive value.Methods A total of 356 T2DM patients admitted in the Endocrinology Department of the Second Affiliated Hospital of Wenzhou Medical University from January 2020 to December 2021 were enrolled,including cases complicated with diabetic retinopathy(DR group)and cases without retinopathy(NDR group)based on fundus color imaging results.The baseline data,related biochemical indicators,bone turnover markers and cytokines of the two groups were compared.The multivariate logistic regression analysis was used to analyze the related factors of DR,and the ROC curve was used to evaluate the predictive value of risk factors for DR.Results The course of diabetes,systolic blood pressure,24-hour urinary protein(24 h-UPr),serum creatinine,serum urea nitrogen,endogenous creatinine clearance,cystatin C,urineβ2 microglobulin,β-CTX,N-MIDoc and 25-hydroxyvitamin D were significantly associated with DR in T2DM patients(all P<0.05).Multivariate logistic regression analysis showed thatβ-CTX(OR=0.997,P<0.01)was a protective factor,while the duration of diabetes(OR=1.118,P<0.01),24 h-UPr(OR=3.431,P<0.05)were risk factors for DR in T2DM.The area under ROC curve(AUC)of the duration of diabetes combined with 24 h-UPr andβ-CTX for predicting DR was 0.769;taking 8.5 years, 0.135 g/24 h and 500 pg/mL as the optimal cut off values respectively, the sensitivity and specificity of the combination of 3 indicators were 0.701 and 0.696, respectively. Conclusion The lower β - CTX level, the longer course of diabetes and the higher 24 h-UPr level are independent risk factors for DR in T2DM patients, and the combination of three indicators has a certain diagnostic value for DR.

关 键 词：2型糖尿病 糖尿病视网膜病变 24小时尿蛋白 糖尿病病程 Ⅰ型胶原交联C-末端Beta特殊序列 

分 类 号：R587.2[医药卫生—内分泌] R774.1[医药卫生—内科学]